Utility of Non-Invasive Tests for Evaluating Liver Fibrosis in MetALD

Steatotic liver disease (SLD) is a major contributor to the global burden of liver disease. In 2023, a new disease classification MetALD was introduced to define patients with hepatic steatosis and metabolic dysfunction who also consume moderate amounts of alcohol. Although the individual roles of metabolic and alcohol-related factors in SLD progression are increasingly understood, their combined impact remains poorly defined.
In Japan, the prevalence of MetALD is estimated to be approximately 5%. In our previous multicenter cohort study using vibration-controlled transient elastography (VCTE) across 10 institutions and 6,530 individuals, 560 (8.6%) were diagnosed with MetALD. The MetALD group showed a striking male predominance (male-to-female ratio of 9:1) and was characterized by older age, elevated levels of GGT, triglycerides, HDL cholesterol, and FIB-4, and lower levels of LDL cholesterol compared to the MASLD group.
We assessed the diagnostic performance (AUROC) of several non-invasive tests (NITs), including VCTE, MRE, ELF, type IV collagen 7S, M2BPGi, and FIB-4, for identifying fibrosis stages >F2 and >F3. After propensity score matching for potential confounders (age, sex, BMI, diabetes, hypertension, and dyslipidemia), AUROCs were compared between MetALD and MASLD groups. For both fibrosis thresholds, AUROCs were comparable between the groups with no statistically significant differences. These findings suggest that NITs validated in MASLD are also applicable to MetALD, although adjustments in cutoff values may be necessary.